Association of Chlorhexidine Use and Scaling and Root Planing With Birth Outcomes in Pregnant Individuals With Periodontitis

Abstract

ImportanceChlorhexidine mouthwash enhances treatment effects of conventional periodontal treatment, but data on chlorhexidine as a source of heterogeneity in meta-analyses assessing the treatment of maternal periodontitis in association with birth outcomes are lacking.ObjectiveTo assess possible heterogeneity by chlorhexidine use in randomized clinical trials (RCTs) evaluating the effect of periodontal treatment (ie, scaling and root planing [SRP]) vs no treatment on birth outcomes.Data SourcesCochrane Oral Health’s Trials Register, Cochrane Pregnancy and Childbirth’s Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Embase Ovid, LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database), US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov), and the WHO International Clinical Trials Registry Platform were searched through March 2022.Study SelectionRCTs were included if they were conducted among pregnant individuals with periodontitis, used interventions consisting of SRP vs no periodontal treatment, and assessed birth outcomes.Data Extraction and SynthesisData were abstracted with consensus of 2 reviewers using Rayyan and assessed for bias with the Cochrane Risk of Bias 2 tool before random effects subgroup meta-analyses. Analyses were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline.Main Outcomes and MeasuresOutcomes of interest were preterm birth (ie, <37 weeks’ gestation) and low birth weight (ie, <2500 g).ResultsThere were 12 studies with a total of 5735 participants evaluating preterm birth. Control group participants did not receive any treatment or use chlorhexidine during pregnancy. All intervention group participants received SRP; in 5 of these studies (with 2570 participants), pregnant participants in the treatment group either received chlorhexidine mouthwash or advice to use it, but participants in the remaining 7 studies (with 3183 participants) did not. There were 8 studies with a total of 3510 participants evaluating low birth weight, including 3 studies with SRP plus chlorhexidine (with 594 participants) and 6 studies with SRP only (with 2916 participants). The SRP plus chlorhexidine groups had lower risk of preterm birth (relative risk [RR], 0.56; 95% CI, 0.34-0.93) and low birth weight (RR, 0.47; 95% CI, 0.32-0.68) but not the SRP-only groups (preterm birth: RR, 1.03; 95% CI, 0.82-1.29; low birth weight: RR, 0.82; 95% CI, 0.62-1.08).Conclusions and RelevanceThese findings suggest that treating maternal periodontitis with chlorhexidine mouthwash plus SRP was associated with reduced risk of preterm and low birth weight. Well-conducted RCTs are needed to test this hypothesis.

Effect of Treating Periodontal Disease in Pregnant Women to Reduce the Risk of Preterm Birth and Low Birth Weight: An Umbrella Review

“…The SRs analyzed in this study spanned from 2003 to 2023 and were conducted in various countries, including Saudi Arabia [ 43 ], the United Kingdom [ 21 , 44 ], the United States [ 45 , 46 , 47 , 48 , 49 ], Vietnam [ 50 ], Canada [ 51 , 52 ], Australia [ 53 , 54 ], India [ 55 , 56 ], Brazil [ 10 , 57 , 58 , 59 , 60 ], Germany [ 61 ], Italy [ 62 ], and Greece [ 63 , 64 ]. Additional details regarding the characteristics of these SRs can be found in Table 3 .…”

“…Seven SRs [ 10 , 21 , 44 , 45 , 46 , 50 , 59 ] were considered to have high confidence, fourteen SRs [ 43 , 47 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 61 , 62 , 63 , 64 ] had low confidence, and three SRs [ 48 , 49 , 60 ] had critically low confidence ( Table S1 ).…”

“…Sixteen included SRs [ 10 , 21 , 43 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 53 , 54 , 55 , 56 , 60 , 64 ] reported that PD treatment reduces the risk of PB, while eight SRs [ 44 , 52 , 57 , 58 , 59 , 61 , 62 , 63 ] reported that it did not. Eighteen SRs [ 10 , 21 , 44 , 45 , 46 , 47 , 50 , 51 , 52 , 53 , 54 , 57 , 58 , 59 , 61 , 62 , 63 , 64 ] meta-analyzed the results and found that the OR ranged from 0.44 (CI: 0.20 to 0.98) [ 53 ] to 1.01 (CI: 0.74 to 1.38) [ 62 ] and the RR ranged from 0.37 (CI: 0.16 to 0.84) [ 50 ] to 0.92 (CI: 0.72 to 1.17) [ 58 ]. Alnasser et al [ 43 ], Govindasamy et al [ 55 ], Shah et al [ 56 ], Pimentel Lopes de Oliveira et al ...…”

Fusobacterium nucleatum: An Overview of Evidence, Demi-Decadal Trends, and Its Role in Adverse Pregnancy Outcomes and Various Gynecological Diseases, including Cancers

“…A Polish study [37] stated that the use of zinc ions, commonly found in commercial anti-malodor mouthwashes, can inhibit F. nucleatum. A Columbian systematic review and meta-analysis conducted by Merchant et al [95] indicated that treating maternal periodontitis patients infected with F. nucleatum using chlorhexidine mouthwash, scaling and root planing (SRP) reduces the risk of preterm birth and low birth weight babies. These reports highlight the importance of considering multiple external factors that impact a pregnant woman's oral microbiota and potentially lead to APOs.…”

Bibliometric Analysis of the Knowledge Landscape of Periodontal Disease in Pregnancy: A Noteworthy Multidisciplinary Issue

“…In recent years, some systematic reviews of quantitative analyses on pregnancy and periodontal disease are available, which focus on specific subfields such as the prevalence of periodontal disease in pregnancy, 13 oral microflora, 13 associations of periodontal disease with different adverse outcomes, [14][15][16] or specific interventions to improve prognosis. [17][18][19] However, there is still a paucity of macroscopic analyses of the knowledge profile and topic evolution in the field.…”